Tracing the Chromospheric and Coronal Magnetic Field with AIA, IRIS, IBIS, and ROSA Data

The aim of this study is to explore the suitability of chromospheric images for magnetic modeling of active regions. We use high-resolutionimages (≈0.2"-0.3"), from the Interferometric Bidimensional Spectrometer in the Ca II 8542 Å line, the Rapid Oscillations in the Solar Atmosphere instrument in the Hα 6563Å line, the Interface Region Imaging Spectrograph in the 2796Å line, and compare non-potential magnetic field models obtainedfrom those chromospheric images with those obtained from images of the Atmospheric Imaging Assembly in coronal (171 Å, etc.) and inchromospheric (304 Å) wavelengths. Curvi-linear structures are automatically traced in those images with the OCCULT-2 code, to which we forward-fitted magnetic field lines computed with the Vertical-current Approximation Nonlinear Force Free Field code. We find that the chromospheric images: (1) reveal crisp curvi-linear structures (fibrils, loop segments, spicules) that are extremely well-suited for constraining magnetic modeling; (2) that these curvi-linear structures arefield-aligned with the best-fit solution by a median misalignment angle of μ2 ≈ 4°–7° (3) the free energy computed from coronal data may underestimate that obtained from chromospheric data by a factor of ≈2–4, (4) the height range of chromospheric features is confined to h≲4000 km, while coronal features are detected up to h = 35,000 km; and (5) the plasma-β parameter is β ≈ 10^-5 - 10^-1 for all traced features. We conclude that chromospheric images reveal important magnetic structures that are complementary to coronal images and need to be included in comprehensive magnetic field models, something that is currently not accomodated in standard NLFFF codes.

Conservative fluid management or deresuscitation for patients with sepsis or acute respiratory distress syndrome following the resuscitation phase of critical illness: a systematic review and meta-analysis

Background

It is unknown whether a conservative approach to fluid administration or deresuscitation (active removal of fluid using diuretics or renal replacement therapy) is beneficial following haemodynamic stabilisation of critically ill patients.

Purpose

To evaluate the efficacy and safety of conservative or deresuscitative fluid strategies in adults and children with acute respiratory distress syndrome (ARDS), sepsis or systemic inflammatory response syndrome (SIRS) in the post-resuscitation phase of critical illness.

Methods

We searched Medline, EMBASE and the Cochrane central register of controlled trials from 1980 to June 2016, and manually reviewed relevant conference proceedings from 2009 to the present. Two reviewers independently assessed search results for inclusion and undertook data extraction and quality appraisal. We included randomised trials comparing fluid regimens with differing fluid balances between groups, and observational studies investigating the relationship between fluid balance and clinical outcomes.

Results

Forty-nine studies met the inclusion criteria. Marked clinical heterogeneity was evident. In a meta-analysis of 11 randomised trials (2051 patients) using a random-effects model, we found no significant difference in mortality with conservative or deresuscitative strategies compared with a liberal strategy or usual care [pooled risk ratio (RR) 0.92, 95 % confidence interval (CI) 0.82–1.02, I2 = 0 %]. A conservative or deresuscitative strategy resulted in increased ventilator-free days (mean difference 1.82 days, 95 % CI 0.53–3.10, I2 = 9 %) and reduced length of ICU stay (mean difference −1.88 days, 95 % CI −0.12 to −3.64, I2 = 75 %) compared with a liberal strategy or standard care.

Conclusions

In adults and children with ARDS, sepsis or SIRS, a conservative or deresuscitative fluid strategy results in an increased number of ventilator-free days and a decreased length of ICU stay compared with a liberal strategy or standard care. The effect on mortality remains uncertain. Large randomised trials are needed to determine optimal fluid strategies in critical illness.